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Stopping the malnutrition carousel

Added: (Thu Nov 23 2000)

Pressbox (Press Release) - Stopping the malnutrition carousel: Pioneering guidelines and screening tool launched to combat the UK problem of malnutrition

28 NOVEMBER, HARROGATE

The Malnutrition Advisory Group (MAG) launched the first consensus guidelines and screening tool to tackle the serious public health problem posed by malnutrition. Contrary to popular belief, malnutrition is not restricted to the developing world and is a serious UK public health problem.

The numbers of malnourished patients that are overlooked in UK communities are staggering with studies estimating that anywhere between 45% and 100% of malnourished patients go undetected and untreated1 2.

Malnutrition is frequently unrecognised and untreated in community, hospital and nursing homes and there is currently no nutritional tool and guidelines which comply with strict criteria laid down by the Royal College of General Practitioners, British Dietetic Association and Scottish Intercollegiate Guidelines Network. The MAG guidelines are scientifically rigorous, evidence-based and have been piloted in the community.

Professor Sir George Alberti, President of the Royal College of Physicians commented, “Malnutrition is responsible for a vast amount of preventable ill health. The MAG are to be congratulated on their initiative in attempting to tackle these problems - particularly with regard to the several major groups in the community.”

“The new guidelines, entitled Guidelines for the Detection and Management of Malnutrition in the Community, together with a screening tool, offer a major means to help health professionals detect and manage malnutrition in the community and in a healthcare setting”, said Dr Marinos Elia, Honorary Consultant Physician at Addenbrookes Hospital and Chair of the MAG. “We strongly believe that if the new MAG guidelines were adopted for routine use in the NHS the incidence of malnutrition would be massively reduced. This will improve patient outcome and release scarce NHS resources for other priorities,” Dr Elia added.

The MAG said it hoped this new tool would be of particular use in identifying patients “stuck on the malnutrition carousel” - those undernourished patients who revolve undetected between the community and hospital. Studies have shown that up to 40% of adults admitted to hospital suffer from malnutrition3 4. While in hospital, malnourished patients continue to lose weight and are discharged weighing less than when they were admitted3. Moreover, a malnourished person has a 26% greater chance of a hospital admission than an adequately nourished person5.

The guidelines
“The screening tool that the MAG has developed is simple and convenient to use while the guidelines are designed to provide guidance on the most appropriate nutrition intervention for an undernourished patient”, explained Dr Elia, “and both meet rigorous scientific criteria.” The MAG reviewed 23 existing screening tools currently available and none met the strict criteria laid down by the Scottish Intercollegiate Guideline Network, Royal College of General Practitioners and the British Dietetic Association.

“The new guidelines will help with the education and training of health professionals by making them aware of vital nutrition issues,” commented Jill Ward, MAG member and Dietetic Manager at Rotherham General Hospitals NHS Trust. “A MORI survey commissioned by the Malnutrition Advisory Group found that 60% of GPs felt that they needed further training in malnutrition and 74% of GPs had received no undergraduate training in nutrition6 ” Mrs Ward added.

Malnutrition leads to adverse mental and physical health and delays recovery from disease and illness. The Kings Fund estimated that NHS hospitals alone could save up to £266 million if malnutrition was tackled7.

Support of the guidelines
Harry Cayton, Chief Executive of the Alzheimer’s Society said, “People with dementia are amongst the most vulnerable in our society. Our recent survey Food for Thought showed that as many as 500,000 people with dementia are at risk of undernutrition and that health professionals may not be trained to deal effectively with the problem. We welcome the MAG initiative as a positive move towards greater recognition of malnutrition in people with dementia in the UK.”

Loretta Cox, Chair of the British Dietetic Association said “Dietitians are actively involved in the diagnosis and treatment of malnutrition, which severely compromises health and adversely affects many clinical conditions. With limited resources in the community, dietitians welcome this initiative which will help health professionals to target those most at risk and plan the right treatment. Combating malnutrition early on has been shown to be cost-effective and can greatly improve quality of life.”

Professor Mike Pringle of the Royal College of General Practitioners stated “The MAG initiative will help to raise awareness of malnutrition among GPs and the primary care team. Malnutrition is a significant public health problem which faces many patients in the community.”

Lynn Young from the Royal College of Nursing said, “Malnutrition is a significant health problem. Community nurses are ideally placed to identify and screen people at risk. It is only through committed and tenacious action that the menace of malnutrition will be tackled. This task cannot be without the full co-operation of nurses and other health professionals. This is a team effort. The guidelines will provide nurses with a useful aid to lead the fight, help with training and education, improve awareness and achieve health improvements in
patients.”

The launch of the guidelines to combat malnutrition is supported by the following organisations

Alzheimer Scotland – Action on Dementia
British Nutrition Foundation
Community Practitioners and Health Visitor’s Association
Digestive Disorders Foundation
Eating Disorders Association
Macmillan Cancer Relief
Milk for Schools
Motor Neurone Disease Association
Multiple Sclerosis Society
Patients’ Association
The Royal Society for the Promotion of Health

Notes
1. Members of the press are welcome to attend the guideline launch at the St George’s Hotel, Harrogate on 28 November 2000 from 1200 to 1300.
2. For more information contact Eva Holland 0207 345 3033, Denise Manson Reid 0207 345 3681 or Tom Thorpe 0207 345 3317.
3. Background information is available on www.bapen.org.uk
4. Press copies of the guidelines are available from The MAG, 10 Floor, 10 Cabot Square, London, E14 4QB
5. The guidelines have been launched at the Harrogate conference of the charity the British Association for Parenteral and Enteral Nutrition (BAPEN). The MAG is a standing committee of BAPEN and has a membership of academics, physicians, nurses, a GP, dietitians and a pharmacist
6. BAPEN’s aim is to improve the nutritional treatment of all sufferers from illness who have become or are likely to become malnourished and who are unable to consume or absorb normal food in sufficient quantities
7. The guidelines to detect and manage malnutrition have two elements:
 Screening tool – this detects malnutrition by measuring a person’s body mass index (a measure of weight relative to height) and assessing whether someone unintentionally lost weight over a few months
 Management guidelines – these provide health professionals with guidance on how to manage and treat malnutrition

References
1 Miller DK, Morley JE, Rubenstein LZ, Pietruszka FM, Stome LS. Formal geriatric assessment instruments and care of older general medical outpatients. Journal of the American Geriatric Society 1990; 38: 645-651.
2 Kelly IE, Tessier S, Chil A, Morris SE, Crumley A, Mclaughlin D., McKee RF, et al. Still hungry in hospital: identifying malnutrition in acute hospital admission. Quarterly Journal of Medicine 2000; 93: 93-98.
3 McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994; 309: 945–948.
4 Stratton R, Elia M. How much undernutrition is there in British Hospitals? British Journal of Nutrition 2000; 84: 257-259.
5 Martyn CN, Winter PD, Coles SJ, Edington J. Effect of nutritional status on use of health care resources by patients with chronic disease living in the community. Journal of Clinical Nutrition 1998; 17: 119–123.
6 MORI, 14-25 September 1998.
7 Lennard-Jones, J (eds). A Positive approach to nutrition as treatment: report of a working party. Kings Fund Centre, 1992.
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